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Biomedical subjects

P Emery

Publications and source records attributed to P Emery.

At least 289 records · Page 16Linked to original sources
PubMed1991

Techetium 99m methylene diphosphonate bone scanning in osteoarthritic hands.

In this prospective study, the radiological features characteristic of osteoarthritis of the hand were compared with the radionuclide bone scan images. A total of 32 patients was assessed at 6-monthly intervals for 18 months. Microfocal radiographs were taken at each visit. The high magnification and resolution of this technique permitted direct measurement of joint space width, subchondral sclerosis, osteophyte number and area and juxta-articular radiolucency area for each joint in the hand. Four-hour technetium 99m methylene diphosphonate bone scans were taken at 0 and 12 months and the activity of tracer uptake at each joint scored. The latter was compared with each X-radiographic feature at every visit and the changes between visits analysed. The scan scores did not correlate with any of the X-radiographic features other than osteophyte size. During the study the size of growing and remodelling osteophytes increased significantly at joints with raised or increased isotope uptake.

Female↗
PubMed1991

Acute aortitis and aortic incompetence due to systemic rheumatological disorders.

We report the clinical, laboratory and echocardiographic features of five cases of aortic incompetence associated with ankylosing spondylitis, rheumatoid arthritis and undefined connective tissue diseases. Immunosuppression with steroids and cytotoxic agents was used to suppress aortic root inflammation in four cases; in three the aortic root size stabilized and the patients remain well with no evidence of increasing aortic incompetence. In one case, control of the inflammatory process was never fully achieved for any length of time and the patient died shortly after aortic valve replacement. A fifth case required urgent valve replacement and remains well. A systemic rheumatological disorder should be considered in cases of apparent "lone" aortic incompetence and conversely aortic incompetence should not be overlooked in established systemic rheumatological disease. Immunosuppressive therapy may prevent or delay the need for aortic valve replacement in such cases.

Adult↗
PubMed1991

Venostasis, subclinical vasculitis and von Willebrand factor antigen.

Von Willebrand factor antigen (VW FAg) has been used as a marker for vasculitis and raised levels have been shown to correlate with active disease. The use of VW FAg levels in the diagnosis of vasculitic disorders has been proposed. However, certain cases of vasculitis have normal VW FAg levels and are difficult to diagnose; this is of importance because of the high mortality associated with these disorders. It has been suggested that venostatic stress can be used as a provocative test for stimulating VW FAg release, thereby improving the speed and sensitivity of diagnosis. We tested this hypothesis in a mixed group of 35 patients with vasculitis, systemic lupus erythematosus and rheumatoid arthritis and 16 controls. At baseline, although the levels were not outside the laboratory range, the disease groups had raised VW FAg compared with the simultaneously tested controls. Venostatic stress increased VW FAg activity in all disease groups, control levels also increased and differences between controls and disease groups diminished in significance. Therefore venostatic stress with VW FAg measurement does not produce a more sensitive test for vasculitis. Venostasis should be avoided when measuring VW FAg levels.

Adult↗
PubMed1991

Urinary IL-6: a marker for mesangial proliferative glomerulonephritis?

A prospective study of plasma and urinary interleukin-6 (IL-6) levels was performed in 54 patients undergoing renal biopsy to determine whether detectable urinary IL-6 was a reliable marker for mesangial proliferation. Interleukin-6 was found in both the urine and plasma of seven patients, the urine alone of 15 patients, and the plasma alone of two patients. Interleukin-6 was not detected in the urine or the plasma of the remaining 30 patients, the urine of 10 healthy controls or the urine of 10 patients with rheumatoid arthritis with raised plasma IL-6. Interleukin-6 was found in the urine of only one out of an additional seven patients with lupus nephritis. Urinary IL-6 was associated with a variety of renal abnormalities and was not restricted to those with mesangial hypercellularity. Furthermore, many patients with mesangial hypercellularity did not have detectable urinary IL-6. There was no correlation between urinary IL-6 and plasma IL-6, urinary albumin excretion or urinary creatinine. These results suggest that IL-6 detected in the urine is a marker of renal IL-6 production, but not specifically of mesangial hypercellularity. The patients with IL-6 in the urine had a mean serum creatinine significantly higher than those without IL-6. It is not possible to distinguish at present whether IL-6 contributes to renal dysfunction or whether it reflects renal damage.

Adolescent↗
PubMed1991

Comparison of clinical, radionuclide, and radiographic features of osteoarthritis of the hands.

Simultaneous clinical, scintigraphic, and macroradiographic assessments were carried out on 32 patients with hand osteoarthritis and the results at entry and one year reported. The presence and growth of osteophyte correlated with symptoms and a positive scan. The scan did not detect the radiographic features of juxta-articular radiolucencies, subchondral sclerosis, or cartilage thinning. Osteophytes, particularly when fast growing, produce pain, a 'hot' scan, and may predict disintegration of joint architecture.

Arthrography↗
PubMed1991

Metabolism of low-dose paracetamol in patients with rheumatoid arthritis.

1. Low dose (500 mg) paracetamol (acetaminophen) was administered to patients with rheumatoid arthritis (RA) and to age-matched healthy controls and to hospital controls. 2. At this dose level, patients with RA excreted decreased amounts of paracetamol sulphate (controls means 11.3 +/- 5.1, 10.6 +/- 5.9; RA mean 3.02 +/- 3.7). This difference is statistically significant (P less than 0.001). 3. The mean ratio of excretion of paracetamol sulphate/paracetamol glucuronide was 5.6 +/- 12.1, 5.3 +/- 10.7 in controls but 2.1 +/- 2.7 in RA patients (P less than 0.001). 4. Patients with RA appear to have less capacity for excreting paracetamol as non-toxic conjugates and may be more susceptible to paracetamol toxicity, especially on chronic dosage.

Acetaminophen↗
PubMed1991

[Digestive hemorrhage following gastroduodenal ulcers caused by non-steroidal anti-inflammatory agents].

The aim of this retrospective study was to describe the clinical and prognostic characteristics of bleeding ulcers following gastrotoxic agent use. From 1984 to 1988, 244 patients were admitted in our Intensive Care Unit for bleeding ulcers; 133 (54.5 percent) were using gastrotoxic agents. Patients not taking gastrotoxic agents were compared with patients taking non steroidal antiinflammatory drugs (n = 77) or aspirin (n = 35). Patients receiving non steroidal antiinflammatory drugs differed (P less than 0.05) from patients not taking gastrotoxic agents: they were older, had less history of ulcer, hemorrhage, and alcohol abuse. Patients taking aspirin had less severe hemorrhage and took anticoagulant therapy less frequently than patients not taking gastrotoxic agents. Patients taking aspirin were younger, had less severe hemorrhage and had more frequent history of alcohol abuse and ulcer disease than patients taking non steroidal antiinflammatory drugs. There was no difference with regard to endoscopic data and mortality (7 percent). Two thirds of hemorrhages following non steroidal antiinflammatory drugs occurred during the month following the onset or the modification of treatment. The distribution of non steroidal antiinflammatory drugs in the group of patients who bled after non steroidal antiinflammatory drugs differed from that of regional sales. These results suggest that upper gastrointestinal tract bleeding associated with the use of gastrotoxic agent are frequent, particularly in elderly patients, are not associated with poor prognosis, and occur soon after the beginning of treatment.

Adult↗
PubMed1991

Reduced thiol methyl transferase activity in red blood cell membranes from patients with rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) have a reduced capacity for S-oxidation and formation of drug sulfate conjugates. We investigated S-methylation catalyzed by thiol methyl transferase (TMT) (E.C. 2.1.1.9) as an alternative pathway for metabolism of aliphatic compounds. TMT activity was measured in vitro using red blood cell membrane preparations from 120 patients with RA and 35 controls. Mean values for controls were 10.1 +/- 3 units/mg protein and for RA 3.7 +/- 3 units/mg protein (p less than 0.05). TMT activity was not related to the acute phase response or to drug administration. However, patients with RA with higher TMT activity tended to have higher rheumatoid factor levels. This evidence is consistent with a generalized disturbance of sulfur metabolism in rheumatoid disease.

Aged↗
PubMed1991

Inner ear deafness in Wegener's granulomatosis.

Autoimmune deafness represents a heterogeneous group of disorders in which there is though to be inner ear and/or middle ear damage mediated by various immunological abnormalities. We describe a patient with Wegener's granulomatosis in whom there was evidence of significant inner ear damage caused by vasculitis, which was completely reversed by cyclophosphamide and prednisolone. We propose that Wegener's granulomatosis is a cause of autoimmune deafness.

Adult↗
PubMed1991

The immune response. 2. Systemic mediators of inflammation.

This article deals with the mechanisms by which local immune stimulation is transmitted to the periphery, leading to systemic inflammation. We concentrate on the role of three signalling molecules: interleukin-1, interleukin-6, and tumour necrosis factor alpha. These cytokines provide a direct link between local and systemic inflammation.

Acute-Phase Reaction↗
PubMed1991

Relationship of progression of radiographic changes in hands and wrists, clinical features and HLA-DR antigens in rheumatoid arthritis.

One hundred and twelve hospital based outpatients with rheumatoid arthritis (mean duration +/- standard error, 10.7 +/- 0.9 years) were studied for radiological progression of the hands and wrists over a mean period of 26.5 +/- 0.5 months. The majority were taking slow acting antirheumatic drugs (SAARD). The rate of radiographic progression was positively and independently associated with the female sex (p less than 0.01), erythrocyte sedimentation rate (ESR, p less than 0.05) and HLA-DR1 (p less than 0.05). There was a negative association with HLA-DR4 (p less than 0.05) but this was no longer significant after adjusting for ESR. There was no relationship between the rate of radiological progression and the presence of rheumatoid factor, rheumatoid nodules and duration of treatment with SAARD.

Arthritis, Rheumatoid↗
PubMed1991

The immune response 1. The local response and understanding T cell specificity.

In recent years there have been major advances in our knowledge of the mechanisms that determine the specificity of the interaction between T cells and antigen. This specificity determines self-recognition, controls responses to foreign proteins and when disordered leads to autoimmunity. In this article we describe some of these advances and discuss the implications for our understanding of the inflammatory process and disease.

Antigen-Presenting Cells↗
PubMed1990

Reactive oxygen species modify human DNA, eliciting a more discriminating antigen for the diagnosis of systemic lupus erythematosus.

During the development of an ELISA to measure anti-DNA antibodies in systemic lupus erythematosus (SLE) sera, native dsDNA was found not to be the most appropriate antigen to use in ELISA assays for differentiating between SLE patients and those with rheumatoid arthritis (RA), a disease also associated with circulating serum anti-DNA antibodies. By modifying the ELISA technique to incorporate human DNA, denatured by reactive oxygen species, to detect anti-DNA antibodies in SLE sera, results consistently showed an increase in antibody binding when compared with the native antigen; no such trend was observed in the comparable group of RA patients. Using this assay serum anti-dsDNA antibody levels were measured in a group of 20 controls, 20 RA patients (10 seropositive and 10 seronegative) and 30 SLE patients (15 with clinically active disease, 15 with inactive disease). A comparison with the standard radioimmunoassay used to measure anti-DNA antibodies for the diagnosis of SLE showed that the ELISA assay using modified DNA performed better than the standard radioimmunoassay offering an improvement in both clinical specificity and sensitivity. The improved method particularly reduced the problem of false-negative results for SLE patients shown clinically to be either mildly active or inactive.

Adult↗
PubMed1990

Associations between HLA and antibodies to collagen in rheumatoid arthritis.

Associations between HLA types and serum antibodies to native and denatured type II collagen were sought in 105 patients with rheumatoid arthritis (RA). Antibodies were measured using a solid phase radioimmunoassay. There were no significant associations between any HLA antigen (A, B, or DR) and a high antibody titre to native collagen. There were significant associations, however, between HLA antigens and high antibody titres to denatured collagen. Although DR4 did not show an association, the phenotype A2+DR4+ did; this was not related to A2 as A2+DR- was not associated with a high antibody titre. No single B locus antigen showed an association, but several B locus antigens, B12, B15, and B40, were included in phenotypes with A2 and DR4 which were associated with a high antibody titre to denatured collagen. These HLA associations with anticollagen type II are best explained by a gene other than DR4 (but in linkage with it) which may regulate the antibody response to denatured collagen. If so, this would represent an HLA gene in addition to DR4 that is active in RA.

Antibodies↗